Healthcare practice management remains a fierce battleground. The AMA has defeated over 80 bills in 2024 that would have let nonphysicians practice independently. This victory highlights how vital physician oversight is for patient care throughout the United States.

The scope of practice for nurse practitioners differs vastly between states. This creates a challenging environment for healthcare providers to work in. Recent studies reveal that emergency physicians have 20 times more clinical training than nurse practitioners. These numbers explain why physician scope of practice sparks heated debates. Patient choices support physician-led care strongly – 95% want a physician involved in their diagnosis and treatment.

Our state-by-state guide brings clarity to PA and NP practice authority today. This updated 2025 resource helps you understand the current status of physician assistant full practice authority. You’ll learn how NP practice authority varies by state and continues to evolve despite strong opposition from medical associations.

Understanding Scope of Practice for PAs and NPs

Scope of practice regulations decide what healthcare services PAs and NPs can legally provide. These rules create a complex system that looks very different across the United States.

What is scope of practice?

Scope of practice sets the limits for what licensed medical professionals can do. Nurse practitioners’ duties usually include patient assessment, diagnostic test ordering and interpretation, diagnosis, treatment initiation, medication prescription, and patient education ^[1]. PA’s responsibilities are similar – they can take medical histories, do physical exams, diagnose and treat illness, order tests, create treatment plans, prescribe medication, and handle certain procedures ^[2].

Physicians don’t face these limits, but NPs and PAs must follow different practice restrictions based on their state’s rules.

Why it varies by state

State lawmakers create scope of practice laws by looking at workforce patterns, healthcare access needs, and economic factors ^[3]. The regulations for nurse practitioners fall into three main groups:

• Full Practice Authority – NPs can review patients, diagnose, order tests, and handle treatments on their own under state nursing board oversight. Currently implemented in 27 states and DC ^[4][1].
• Reduced Practice Authority – NPs need lifelong collaborative agreements with physicians or face limits on practice settings. They can do some tasks independently but can’t run their own practices freely ^[4][1].
• Restricted Practice Authority – Physicians must supervise, delegate, or manage NP teams throughout their careers ^[4][1].

PAs work in different settings, but all states require them to have some kind of supervisory or collaborative relationship with physicians ^[5][6].

The role of physician-led care

Medical organizations strongly support physician-led team care models. The American College of Physicians, among other medical groups, points out that physicians’ education, training, and clinical experience stand apart from NPs and PAs ^[7].

These organizations believe nonphysician practitioners should work as valued team members rather than independent providers. People who want expanded scope often point to doctor shortages. Research shows that letting NPs practice independently doesn’t always help rural and underserved areas get better care. NPs tend to work in the same locations as doctors ^[3][8].

Medical associations keep shaping advanced practice policies nationwide. They actively oppose laws that would let nonphysician practitioners work outside physician-led teams ^[7].

State-by-State Overview of NP and PA Practice Authority

The rules governing nurse practitioner and physician assistant practice authority continue to evolve across the nation. This has created a complex mix of regulations that shapes how advanced practice works throughout America.

Full practice authority states

27 states plus Washington D.C. now allow nurse practitioners to operate with full practice authority ^[9]. NPs in these areas can assess patients, diagnose conditions, order and interpret diagnostic tests independently. They can also manage treatments while being accountable to their state nursing board. The states with full practice authority include:

• Alaska, Arizona, Colorado, Connecticut
• Hawaii, Idaho, Iowa, Maine
• Montana, Nevada, New Hampshire, New Mexico
• North Dakota, Oregon, Rhode Island, Vermont

The American Association of Nurse Practitioners supports this model. Both the National Academy of Medicine and the National Council of State Boards of Nursing recommend this approach ^[4].

Reduced practice authority states

Twelve states have reduced practice authority that limits NP independence in at least one aspect of their work ^[9]. These states require collaborative agreements with physicians for specific parts of patient care. Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, West Virginia, and Wisconsin fall into this category ^[9].

Restricted practice authority states

Eleven states require career-long supervision or delegation from physicians ^[9]. Florida’s NPs cannot diagnose or treat patients without a physician available. Texas requires a Prescriptive Authority Agreement for medication management ^[10]. California (which is transitioning), Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, and Virginia also have restricted practice ^[9].

Notable changes in 2025

California leads the most important changes in 2025’s regulatory map. The state started moving from restricted to full practice in January 2023 under AB 890 ^[11]. California’s qualified NPs must complete 4,600 hours of supervised practice to gain independence. The state expects full implementation by 2026 ^[12].

Massachusetts has adopted a new approach to full practice authority. NPs must complete two years of supervised prescriptive practice before working independently ^[13]. New York has proposed new laws to reduce collaboration requirements, especially for NPs who serve underserved areas ^[12].

Recent Legislative Wins and Losses in 2025

Advanced practice providers experienced dramatic changes to their scope of practice laws across the country in 2025. State legislatures altered the map with sweeping reforms.

States that expanded NP/PA roles

Full practice authority legislation reached new heights nationwide this year. Five states—Michigan, Alabama, Louisiana, South Carolina, and Wisconsin—joined other full practice authority states in 2025 ^[14]. This shows how far we’ve come from the days when only 22 states and DC gave nurse practitioners such authority. California’s move toward independent practice continues to progress, and the state expects complete implementation by 2026 ^[12].

The landscape keeps evolving as Ohio and Kansas expanded their practice frameworks. These additions brought the total to 34 states plus DC that now give full practice authority to NPs ^[14]. Most of these states picked up on transition-to-practice models that require supervised practice hours before granting independent practice rights.

States that blocked expansion efforts

Physician organizations successfully stopped several scope expansion attempts in 2025. Georgia’s lawmakers voted down two bills (SB 102 and HB 445) that would have let certified registered nurse anesthetists work without physician supervision ^[2]. Mississippi’s medical association blocked all but one of these eleven scope of practice bills in their state legislature ^[2].

South Dakota saw SB 175—a bill that would have given physician assistants full practice authority—fail on the Senate floor. This marks the third straight year such legislation didn’t pass ^[2]. Indiana also stopped expansion bills that four different non-physician provider groups proposed, including changes that would have removed collaboration requirements for advanced practice nurses ^[2].

Key bills to watch this year

Pennsylvania leads the charge with Senate Bill 25 and House Bill 739. These bills aim to give nurse practitioners full practice authority after they complete 3,600 supervised hours—the longest transition period any state requires ^[15][16]. Governor Shapiro backs this policy change and points to its potential help for rural healthcare shortages, where one primary care physician serves 522 residents ^[17].

More changes could come as Missouri, Georgia, and Mississippi have pending legislation ^[14]. These states might follow the recent trend toward fewer practice restrictions.

Tools and Resources for Navigating Scope of Practice

PAs and NPs need specialized resources to navigate their complex regulatory environment. These resources help practitioners and stakeholders understand scope of practice regulations nationwide.

AMA’s Health Workforce Mapper

The AMA Health Workforce Mapper is a free, interactive tool that shows how healthcare professionals spread across America ^[18]. This tool lets users:

• Filter physicians and non-physician providers by specialty and employment setting
• Identify potential areas of workforce deficiency or overlap
• View locations of hospitals, rural health clinics, and other healthcare facilities
• Access patient health data including morbidity rates and health behaviors

Through collaboration with the American Academy of Family Physicians Robert Graham Center ^[18], this tool disproves claims about improved access through independent practice. The mapper shows that non-physicians practice in the same areas as physicians, even in states with independent practice, rather than serving underserved regions ^[19].

Model legislation and templates

The AMA provides legislative templates and model bills that help start the lawmaking process for advanced practice management advocates ^[20]. These resources include physician-led team models, collaborative drug therapy management frameworks, and templates for state-based scope of practice review committees ^[20]. Such tools help you retain control while defining NP practice authority by state.

Truth in Advertising campaign

The AMA’s Truth in Advertising campaign now runs in over 20 states ^[20]. Healthcare providers must clearly tell patients about their training, education, and licensing. Nursing organizations think this legislation duplicates existing HIPAA laws ^[21]. Yet the campaign grows as it prevents confusion when patients meet various doctorate-prepared practitioners.

State law comparison charts

State law charts compare physician assistant full practice authority and nurse practitioners’ scope of practice by state ^[20]. These resources detail prescriptive authority, supervision requirements, and practice settings in all jurisdictions ^[22]. Practitioners learn about their state’s regulatory environment from these comparison tools as the digital world changes faster.

Conclusion

PA and NP practice authority in the United States remains a contentious and ever-changing issue. Five more states granted full practice authority to NPs in 2025. This change brought the total to 34 states plus DC. In spite of that, physician organizations strongly oppose these moves and have blocked many expansion bills in several states.

Advanced practice providers face major challenges due to these varying state regulations. Understanding your state’s specific rules is crucial to manage your practice effectively. States like California and Massachusetts have introduced compromise models. These models require supervised practice hours before granting independence. This approach could show the way forward in this ongoing debate.

Physician groups claim that expanded practice authority doesn’t improve healthcare access in underserved areas. The AMA Health Workforce Mapper data supports this view. Non-physician practitioners typically work in the same locations as physicians instead of filling gaps in rural communities. Physician groups continue to advocate for team-based care models under physician leadership.

Healthcare practitioners must stay alert as regulations keep evolving. Some regions show growing support for expanded scope, yet strong resistance exists, especially in states with restricted practice history. PAs and NPs must track their state’s specific regulations. Physician groups work to maintain proper oversight within collaborative healthcare teams. Whatever side you take in this debate, one thing is clear – discussions about the best healthcare delivery models will shape policy decisions for years ahead.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

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